SA’s Malaria Elimination Policy Under the Microscope

Dr Khumbulani Hlongwana.

Research conducted by UKZN Public Health Medicine lecturer Dr Khumbulani Hlongwana has revealed multiple factors affecting South Africa’s malaria elimination policy from the perspective of implementers, researchers and policy makers.

‘The overarching challenge is the perception that the whole malaria elimination agenda was externally sculpted, with superficial participation by local actors,’ said Hlongwana.

His study culminated in the development of a conceptual framework illustrating features affecting the implementation of malaria elimination in South Africa.

Supervised by Professor Joyce Tsoka-Gwegweni, Hlongwana investigated stakeholders’ understanding of the malaria elimination policy in South Africa, including perceived barriers and facilitators to effective policy implementation.

Titled: “Factors Influencing the Implementation of the Malaria Elimination Policy in South Africa”, the study followed a constructivist epistemological approach which manifests in phenomenological study design. For quantitative aspects, the study used cross-sectional design located within the positivist paradigm.

One of the publications emanating from this study was based on 12 key informants who were questioned using semi-structured interviews. The questions searched for knowledge of the policy and its achieveability, including perceived barriers and facilitating factors to effective implementation. The hybrid approach was used to perform thematic data analysis.

According to Hlongwana, malaria remains a problem in South Africa, exacerbated by staff attitudes and poor capacity, lack of resources, lack of new effective intervention tools, lack of intra- and inter-departmental collaboration, poor cross-border collaboration and weak stakeholder collaboration.

‘Informants were concerned about the target year (2018) for elimination, and about the process followed in developing the policy, including the perceived malaria epidemiology shortfalls, regulatory issues and political context of the policy,’ he said. ‘The past decade has seen a substantial global reduction in malaria morbidity and mortality due to increased international funding and decisive steps by the international malaria community to fight the disease. South Africa has been declared ready to institute malaria elimination, however, research on the factors that would affect this policy implementation is inadequate.’

Hlongwana is currently supervising masters and PhD students. ‘Interestingly, between April and now, I have managed to push three of my masters students to submit their protocols to BREC (the Biomedical Research Ethics Committee). As a BREC member myself, my share of protocol review has substantially increased since completing my PhD.’

‘I am involved in research capacitation training workshops, targeting masters and PhD students. I have infused my training with ethics issues, in order to minimise the number of ethically flawed protocols submitted to BREC. This in turn helps the students and BREC reviewers alike.’

He continues to be involved in a collaborative project titled: “From Malaria Control to Sustainable Elimination: Cluster Randomised Trial Comparing Targeted Versus Generalised Vector Control in South Africa, which is taking place in Limpopo and Mpumalanga”.

Collaborators include the London School of Hygiene and Tropical Medicine (LSHTM), and Wits University. Hlongwana wants to expand his research areas to include work on research ethics.

Hlongwana said his love for research grew during his time at the Medical Research Council. ‘There is no doubt I have a passion for developing others, especially in the areas of research, which makes academia my home. Applying and securing big grants will facilitate the dream of scaling up the capacitation of others in research and research driven interventions.’

Words and photograph by: Nombuso Dlamini